Chlamydia pneumoniae seropositivity in patients with cerebral ischemic attack with or without silent brain infarcts

Chlamydia pneumoniae infection and cerebrovascular disease: a systematic review and meta-analysis

Background

A wealth of published studies have been published on association between Chlamydia pneumoniae (C.pneumoniae) infection and cerebrovascular (CV) disease, but the results were inconsistent. This meta-analysis provides a systematic review of the available evidence from all serological and pathological studies of CV disease and C.pneumoniae.

Methods

A comprehensive research was conducted of MEDLINE, EMBASE, CNKI, WanFang technological periodical database and reference lists of articles to identify eligible case-control and cohort studies. Odds radio (OR) was calculated for each study outcome. Random effect model was used as pooling method and publication bias was estimated for the results.

Results

Fifty-two published studies that met criteria were selected. In case control studies, an association between C.pneumoniae infection and CV disease was revealed by serum specific IgG (OR, 1.61; 95% CI: 1.34 to 1.94), serum IgA (OR, 2.33; 95% CI: 1.76 to 3.08) and PCR technique of C.pneumoniae in peripheral blood cells (OR, 1.90; 95% CI: 1.17 to 3.07). No significant association was found in serum anti-C.pneumonae IgM seropositivity or in-situ-detection of C.pneumoniae in arterial biopsies with CV disease. Subgroup analysis by available studies suggested that C.pneumoniae may paly a role in atherosclerotic stroke, but be less significant in stroke of cardioembolism or other etiologies.

Conclusion

Association between C.pneumoniae infection and CV disease depends on the analytical method adopted, which seems stronger with stroke due to large artery atherosclerosis. Establishing a causal relationship between C.peumoniae infection and CV disease will require more prospective studies with combination of techniques and stratified by etiological subtypes.

Outcome of Chlamydia pneumoniae associated acute ischemic stroke in elderly patients: a case-control study

BACKGROUND

Limited data exists about the role of Chlamydia pneumoniae elderly patients with acute ischemic stroke.

OBJECTIVE

To study the role of C. pneumoniae in elderly patients (age more than 65 years) with acute ischemic stroke and its impact on stroke out come.

METHODS

We recruited 100 elderly patients with acute ischemic stroke and 100 age and sex matched controls over a period of 2 years. IgG and IgA anti C. pneumoniae antibodies were measured by microimmunofluorescence technique in patients and controls. Good outcome was defined as a Modified Rankin score (mRS) of ≤2.

RESULTS

We found C. pneumoniae antibodies in 35% stroke patients and in 18% control subjects (p=0.01). Good out come at 90 days follow up was found in 20/35(57.1%) seropositive stroke patients compared to 37/65(56.9%) seronegative stroke patients (p=0.9).

CONCLUSIONS

C. pneumoniae antibody positivity was independently associated with ischemic stroke in elderly patients and its presence does not alter the stroke outcome.

Is Chlamydia pneumoniae seropositivity associated with atherothrombotic cerebrovascular infarction?

BACKGROUND AND OBJECTIVE

Several studies suggested that Chlamydia pneumoniae (CP) infection may be a risk factor for cerebrovascular disease. Since these studies have reported controversial results, we performed this study to identify whether Cp-immunoglobulin was associated with atherothrombotic cerebrovascular infarction (ACI) in Iranian patients.

MATERIALS AND METHODS

Forty-five patients admitted with ACI, and 45 control without ACI were enrolled in this case-control study. Using an enzyme-linked immunosorbed assay kit (ELISA), the presence of CP-immunoglobulin (CP-IgG) in studied patient's sera was determined.

RESULTS

The seroprevalence of CP-IgG was 35(77.7%) in the ACI group (mean age=73.3 years) and 29(64.4%) in the control group (mean age=70.1 years) (P>0.05). There was no difference in sex, age, hypertension, smoking, hyperlipidemia, diabetes and obesity between cases and control groups (P>0.05). No association was observed between CP seropositivity and ACI [OR: 1.95 (95% CI, 0.081-2.03), P=0.16].

CONCLUSION

Our finding suggests that there is no association between ACI and positive CP-IgG in Iranian patients.

Chronic Chlamydia pneumoniae Infection and Stroke in Cameroon

Background and Purpose— To determine the relationship between chronic Chlamydia pneumoniae infection and stroke in Cameroon.

Methods— Sixty-four consecutive stroke patients 26 to 80 years of age were enrolled at 2 tertiary hospitals in Yaoundé, Cameroon, between March 2000 and December 2001 and matched for age and sex to 64 controls. We measured IgG (1/64) and IgA (1/16) titers against C pneumoniae in both patients and controls using a validated microimmunofluorescence technique.

Results— There was no significant difference between cases and controls with respect to hypertension ( P =0.2), smoking ( P =0.53), alcohol intake ( P =0.8), body mass index ( P =0.49), waist-to-hip ratio ( P =0.14), and diabetes ( P =0.76). IgA antibodies were detected in 50 (78.1%) patients and 27 (42.2%) controls (odds ratio [OR] 4.29; 95% CI, 1.84 to 11.56; P =0.0002), and IgG antibodies in 41 (64.1%) patients and 35 (54.7%) controls (OR, 1.46; 95% CI, 0.68 to 3.22; P =0.29). For confirmed thrombotic stroke, the association with IgA antibodies became stronger (OR, 21.0; 95% CI, 3.38 to 868.45; P <0.0001), but there was still no association with IgG antibodies (OR, 1.86; 95% CI, 0.69 to 5.50; P =0.18).

Conclusions— Our study shows a strong statistical association between (IgA, and not IgG, as a serological marker of) chronic C pneumoniae infection and stroke for the first time in a resident indigenous African population. These findings, if confirmed, may have important policy implications (in terms of antibiotic use in stroke prevention) in sub-Saharan Africa.